DESCRIPTION: (Applicant's Description) The work of the Human Genome Project has dramatically influenced our understanding of human genes and their role in carcinogenesis and has led to the commercial availability of genetic tests for several cancers. As more genes are discovered and their role in cancer development better understood, there will be increasing pressure for genetic testing services. Because of their strong background in clinical oncology, health education and counseling, oncology nurses are being, called upon to complement the limited number of cancer genetic specialists delivering cancer risk counseling services. Traditionally, nurses have not received formal genetic education. To address this deficiency, the Fox Chase Cancer Center has developed a program to train nurses in cancer risk assessment. The course, now attended by over 160 nurses, has translated into an increase in knowledge of cancer genetics and risk assessment. However, knowledge did not uniformly translate into practice. Nurses will need further preparation combined with opportunities for practicing skills to confidently address the complexity of genetic information and the multiple needs of individuals at risk for cancer. The Fox Chase Cancer Center proposes to develop and evaluate an advanced training for nurses in cancer risk counseling. The program will be targeted to nurses who have already acquired a basic understanding of cancer genetics and will be designed to enhance their practice of skills in cancer risk, and in preparing patients for receipt of genetic test information. To achieve this aim, the Population Science Division proposes to develop and conduct an intensive skills-based training course covering the following content in four modules: 1) cancer risk assessment and communication; 2) genetic testing and informed consent issues; 3) ethical, legal and psychosocial issues related to genetic testing; and 4) communication of genetic test results and disclosure counseling. Each module will emphasize skills development following an adult learning-based format including: presentation of performance objectives; observational learning using video presentations; case presentations to enhance critical thinking skills; practice with a proxy patient. Performance feedback will be integral to each session utilizing discussions which will prepare nurses to approach cancer risk counseling as a consultative process shared with other health professionals. The practice opportunities provided by this course will help to enhance the translation of knowledge in cancer risk counseling into practice. Ultimately the training will help to alleviate the shortage of professionals trained in cancer genetic risk counseling.